Such a combined endo-perio lesion, or apicomarginal defect, carries the risk of epithelial downgrowth along the denuded root surface following apical surgery (2).
If root-end filling blocks bacterial leakage from the root-canal system, and no lateral canals are present, one may expect healing of apicomarginal defects providing that epithelial downgrowth along the denuded root surface can be prevented.
Epithelial downgrowth is an uncommon but serious complication which is characterized by cysts or translucent membranes (derived from ocular surface epithelial cells) covering the intraocular structures like corneal endothelium, iris surface, and ciliary body.
With clinical suspicion of epithelial downgrowth, argon laser photocoagulation was performed over anterior iris stroma to confirm diagnosis, but no bleaching was achieved in any of multiple shots targeting different parts of the iris.
Clinically, epithelial downgrowth may appear in form of cysts or sheets covering any intraocular structure.
Most accurate method for the diagnosis of epithelial downgrowth is histopathologic analysis.1,7 Definitive diagnosis of epithelial downgrowth conventionally needs tissue sample by paracentesis and/or biopsy and subsequent histopathological analysis.
However, in the last two decades, as technological advances in the imaging systems of the anterior segment provided better patient care, diagnosis methods for epithelial downgrowth also improved gradually.
During the management of this case, ASOCT was helpful to raise clinical suspicion of epithelial downgrowth. ASOCT provided two main clinical aspects: relationship of sheet-like epithelial membrane with corneal endothelium and assessment of the iridocorneal angle.
In cases with epithelial downgrowth, IOP rise is a devastating complication resulting in refractory glaucoma.
The literature repeatedly points to primary stability as essentially the most important osseointegration determinant because it allows for vital bone maintenance, clot stabilization, and prevention of soft tissue collapse and epithelial downgrowth
. In other words, primary stability is dependent on several other selection criteria (see below), and the ideal immediate implant site should have a significant amount of supporting alveolar bone.
Chapters incorporate experience sections with scientific information on imaging and diagnostics, ocular surface disorders, infectious diseases, inflammatory diseases, neoplasia and epithelial downgrowth
, dystrophies and degenerations, and refractive surgery.